Dental Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report
Non-ischaemic cardiomyopathy (NICM) encompasses a heterogeneous group of disorders that includes genetic, idiopathic, post viral and inflammatory cardiomyopathies. NICM is associated with an increased risk of ventricular arrhythmias (VAs), namely in the form of ventricular tachycardia (VT). Although implanted cardiac defibrillators (ICD) may prevent sudden death from VA, NICM patients may suffer from recurrent symptoms and ICD therapies, and anti-arrhythmic drug side effects. Catheter ablation is highly efficacious in NICM, however poses unique challenges when compared to post myocardial infarction substrates.
Mapping of scar-related ventricular tachycardia (VT) in structural heart disease is fundamentally driven by identifying the critical isthmus of conduction that supports re-entry in and around myocardial scar. Mapping can be performed using activation and entrainment techniques during VT, or by substrate mapping performed in stable sinus or paced rhythm. Activation and entrainment mapping requires the patient to be in continuous VT, which may not be haemodynamically tolerated, or, if tolerated, may lead to adverse sequelae related to impaired end organ perfusion.
Animal studies in the 1960s first demonstrated the benefits of using epinephrine alongside external compressions and external shock to achieve return of spontaneous circulation (ROSC) in arrested and asphyxiated dogs.1–4 Since then, epinephrine has become integral to the performance of advanced cardiac life support (ACLS) care. The American Heart Association’s (AHA) recommendations in the Emergency Cardiovascular Care (ECC) Guidelines are that a standard dose of 1 mg of 1:10,000 epinephrine every 3–5 minutes “may be reasonable for patients with cardiac arrest.”5 No maximum total dose is deline...
Ventricular arrhythmias are one of the leading causes of death in patients with a prior myocardial infarction. Implantable cardioverter-defibrillators (ICDs) are very effective in the prevention of sudden cardiac death but the risk of recurrence remains an issue since defibrillation does not alter the underlying substrate. Recurrent ICD shocks are distressing and are associated with an increase in mortality. Catheter ablation is an effective treatment for recurrent ventricular tachycardia in these patients, particularly when antiarrhythmic therapy produces side effects or is ineffective.
Ablation of ventricular tachycardia (VT) has evolved around the concept of ischemic scar, providing the substrate for ventricular macro-reentry. These early concepts enabled the development of classical mapping techniques and ablation strategies, as exemplified by the seminal work of the late Marc Josephson . Today, electrophysiologists are confronted with more heterogeneous etiologies, resulting in more challenging substrates.
Clinical Predictors of Recurrent Ventricular Arrhythmias in Secondary Prevention Implantable Cardioverter Defibrillator Recipients With Coronary Artery Disease - Lower Left Ventricular Ejection Fraction and Incomplete Revascularization. Circ J. 2018 Oct 11;: Authors: Takano T, Tanaka K, Ozaki K, Sato A, Iijima K, Yanagawa T, Izumi D, Ozawa T, Fuse K, Sato M, Tanabe N, Minamino T Abstract BACKGROUND: The implantable cardioverter defibrillator (ICD) is a standard prevention therapy for patients at high risk for sudden cardiac death (SCD) due to life-threatening ventricular arrhythmia (VA), that is, ve...
Defibrillator technology for sudden cardiac death (SCD) prevention now includes the transvenous implantable cardiac defibrillator (ICD), subcutaneous ICD (S-ICD) and wearable cardioverter defibrillator (WCD). ICD use improves survival in patients who survived previous sudden cardiac arrest (SCA) due to ventricular tachycardia (VT)/ventricular fibrillation (VF), as well as in patients who experienced haemodynamically significant VT. It is also currently indicated for primary prevention in ischaemic/non-ischaemic cardiomyopathies, certain congenital heart disease conditions and inherited channelopathies.
ConclusionsWe present a case of catecholaminergic polymorphic ventricular tachycardia associated with a novel single point mutation in the RyR2 gene, which, to the best of our knowledge, has not been described in the literature so far. Our patient experienced arrhythmic events under both resting conditions and physical activity, an uncommon finding in patients with catecholaminergic polymorphic ventricular tachycardia. This novel mutation may cause arrhythmias independent of sympathoadrenergic stimulation, but further evidence is needed to prove causality.
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